Self-care for the caregiver.

Palliative care nurses can face unique stressors and compassion fatigue working in their field. Working with the dying and their families, communicating with other health care professionals, and handling ethical issues are often sources of stress in palliative care. The biochemistry and theory of stress are discussed. Various strategies to cope with caregiver stress are explained.

Communication skills: breaking bad news in the clinical setting.

Oncology nurses need to develop expert communication skills, especially when delivering bad news to patients and families. Patients and families differ in their needs for levels of information, interpretation of information delivered to them, and responses to unfavorable news. When bad news is delivered in a sensitive and caring manner, morale can be maintained, and the process of coming to terms with illness or death is possible through realistic expectations and hope. It is valuable for nurses to elicit patients' or family members' understanding of what is happening to them, and what they need is key in the process of communicating in a crisis time. Also, skill in responding to feelings and not the content of expression is necessary to the process of recovery. So many improved cancer treatments exist, but the goal of effectively communicating bad news with respect and caring is just as important as treating the person who happens to have cancer.

A comparative analysis of individuals with spinal cord injury who differ in unplanned utilization of health services.

The purpose of this descriptive study is to describe the profile of individuals with spinal cord injuries (SCI) who frequently use health care services in an unplanned manner so that nursing interventions could be designed to decrease utilization. The medical records of 78 subjects with SCI were reviewed for demographic and injury-related variables, comorbid health conditions, discharge disposition, and health care utilization for five years. Based on the rate of unplanned utilization of health care services, three groups of users were identified: non-user, low-user, and high-user groups. Results indicated that high users, compared to non-users and low users, had a higher substance-use rate, a higher unemployment rate at the time of the most recent health care visit, and more violent causes of their SCI. Findings suggest four clinically meaningful trends that have practical implications for nurses related to marital status, substance use, employment status, and etiology of injury. Results of this study laid the foundation for future research aimed at devising a more in-depth risk profile of high users of health care services in the SCI population.

Clinical nursing judgment related to reducing the incidence of falls by elderly patients.

The incidence of falls among elderly patients has been and continues to be a major challenge for nurses. Falls add physical injury and mental stress to patients' existing health problems, are a deterrent to rehabilitation, and increase healthcare costs. This study describes the variables that nurses identify as influencing their clinical decision making and the nursing behaviors associated with preventing patient falls. The study was grounded in the theory that discretionary nursing behaviors are related to nursing expertise, and the study was guided by the assumption that such behaviors are proactive and anticipatory. An analysis of interviews of registered nurses (n = 14) working on a geriatric rehabilitation unit in a medical center in Ohio focused on the zones of association and the contextual meanings of language used by the nurses when discussing patient falls. Four themes emerged: the reasons for patient falls, identifying patients who are likely to fall, preventing falls, and nurses' feelings when patients fall.

Geriatric falls: prevention strategies for the staff.

1. Multiple falls and injuries are more prevalent among elderly over the age of 75 and are the second leading cause of accidental death in the elderly. The risk for falling is noted to be significantly greater in the hospitalized elderly. 2. Review of retrospective quality improvement chart audits revealed that peak fall times were associated with the patient's need for toileting, rest, and obtaining nutrition and hydration. 3. The MetroHealth Falls Prevention Program is based on simple proactive measures to prevent falls in the elderly. 4. An effective falls prevention program has several implications for gerontological nursing practice, including less restraint use, increased patient autonomy, and decreased loss of self-esteem. There is also a sense of increased nursing control over patient safety and time management, as well as implications for further nursing research.

Molecular mimicry in Lyme disease: monoclonal antibody H9724 to B. burgdorferi flagellin specifically detects chaperonin-HSP60.

A monoclonal antibody (H9724), specific for the 41-kDa flagellar protein of the Lyme disease pathogen Borrelia burgdorferi, cross-reacts with human axons and detects one major protein in human neuroblastoma cell extracts. The homologous cross-reacting protein has now been isolated from calf adrenal and identified as chaperonin-HSP60 by N-terminal sequencing.

Using diversional activity to enhance coping.

Diversional activity deficit, a nursing diagnosis that occurs with prolonged hospital treatment, requires creative and practical ways for nurses to support patients. A tool designed to assess diversional needs is described. Benefits include improved relationships and enhanced patient coping with a minimum of cost and inconvenience.